ABSTRACT
Hypertension is a pathology of high prevalence in the world. In Brazil, it is the main risk factor for the major cause of death in the country, coronary heart disease. The May Measurement Month Campaign in 2018 (MMM18) included a population with representation from all Brazilian states and reflects some of the characteristics of hypertension in Brazil. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 12 413 individuals, 59.1% were white, 51.3% were women. The average age was 54. ± 16.0 years. Diabetes was present in 11.6%, previous myocardial infarction in 5.9%, and previous stroke in 2.7%. Current smokers were 9.3% and 12.4% were regular drinkers. The average body mass index was 27.3 ± 4.5 kg/m2. After multiple imputations, 67.9% were hypertensive (>140/90 mmHg). Of the individuals who were not taking antihypertensive medication, 27.9% were hypertensive and of those taking antihypertensive medication, 40.3% were uncontrolled. Systolic BP increased with age. The MMM18 campaign demonstrated a large number of unknown hypertensives and a high rate of uncontrolled hypertension in Brazil, unfortunately in keeping with 2017 findings.
ABSTRACT
O bloqueio do sistema renina angiotensina aldosterona é uma estratégia fundamental no tratamento e prevenção da doença cardiovascular. No contexto da hipertensão arterial (HAS), os inibidores da enzima conversora de angiotensina e os bloqueadores dos receptores de angiotensina compõem, juntamente com os diuréticos tiazídicos e os antagonistas dos canais de cálcio; o tripé fundamental no tratamento farmacológico da HAS. Adicionalmente, estas classes de fármacos são comumente usadas em pacientes com insuficiência cardíaca, doença arterial coronariana, diabetes e doença renal crônica. Neste ponto de vista os autores discutem as semelhanças e diferenças entre inibidores da enzima conversora de angiotensina e os bloqueadores dos receptores de angiotensina, demonstrando que, à luz dos conhecimentos disponíveis atualmente na literatura, é possível reconhecer que essas duas classes de fármacos são diferentes e têm efeitos clínicos distintos
Blockade of the renin angiotensin aldosterone system is a fundamental strategy in the treatment and prevention of cardiovascular disease. In the context of arterial hypertension, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers make up, along with thiazide diuretics and calcium channel antagonists; the fundamental tripod in the pharmacological treatment of SAH. In addition, these classes of drugs are commonly used in patients with heart failure, coronary artery disease, diabetes and chronic kidney disease. From this point of view, the authors discuss the similarities and differences between angiotensinconverting enzyme inhibitors and angiotensin receptor blockers, demonstrating that in light of the knowledge currently available in the literature, it is possible to recognize that these two classes of drugs are different and have distinct clinical effects
ABSTRACT
Data on the association of blood pressure (BP) phenotypes with office and out-of-office markers of vascular stiffness and pressure wave reflection are sparse. This study investigated office and 24-h measures of brachial BP, pulse wave velocity (PWV), and central augmentation index (AIx) across hypertension phenotypes among individuals not using BP-lowering medications [normotension (NT), white-coat hypertension (WH), masked hypertension (MH) and sustained hypertension (SH)] and those using BP-lowering medications [controlled hypertension (CH), white-coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and sustained uncontrolled hypertension (SUCH)]. We evaluated 454 untreated (age = 45 ± 15 years, 50% males) and 238 treated (age = 52 ± 15 years, 45% males) individuals who underwent office and 24-h brachial BP, PWV, and AIx measures using a Mobil-O-Graph PWA monitor. In the analysis adjusted for age and sex, WH had higher (p < 0.05) office PWV (7.53 ± 0.09 vs 6.89 ± 0.05), office AIx (27.9 ± 1.3 vs 23.8 ± 0.8), and daytime AIx (24.6 ± 0.7 vs 22.7 ± 0.4) compared with those of NT, while WUCH had higher (p < 0.05) office PWV (8.28 ± 0.11 vs 7.43 ± 0.08) and 24-h PWV (7.54 ± 0.09 vs 7.21 ± 0.07) than those of CH. MH had higher (p < 0.05) 24-h PWV (7.00 ± 0.09 vs 6.69 ± 0.04) and 24-h AIx (24.3 ± 0.9 vs 21.9 ± 0.4) than those of NT, whereas MUCH had higher (p < 0.05) 24-h PWV (7.64 ± 0.13 vs 7.21 ± 0.07) than that of CH. Lastly, SH or SUCH had significantly higher office and 24-h PWV and AIx than those of NT and CH, respectively. In conclusion, these results suggest that individuals with masked BP phenotypes are more predisposed to have adverse out-of-office vascular characteristics, while individuals with white-coat phenotypes have adverse office and out-of-office vascular characteristics compared with those of individuals with normal BP levels.
